假体隆乳术后形态不佳的矫治

目的探讨假体置入隆乳术后形态不佳的原因和矫治方法。方法根据临床表现将乳房不佳分为5种类型：圆球型、上部膨隆型、下坠型、单侧双乳型及不规则型。通过松解纤维囊、纤维囊折叠缝合、重新分离隆乳腔隙、更换假体、乳房悬吊术等方法，进行矫治再次隆乳术。结果经过至少6个月随访观察，本组106例均获得了满意的手术效果。结论隆乳术后乳房形态不佳主要与假体体积过大、腔隙分离不到位、假体移位、乳房下皱襞过度分离、纤维囊挛缩及引流、包扎位置不当等因素有关，针对不同原因实施相应的手术方法矫治，能够获得满意的手术效果。     

眉间"川"字纹手术方法的改良与应用

眉间“川”字纹是临床常见的面部衰老表现，如何先择适当手术方案使之减轻并保持长期稳定的效果，从而实现有效面部年轻化，一直是美容外科关注的热点问题，我们自2002年以来通过眉间纹邻近切口，采用复合组织瓣或自体游离组织进行矫正获得较好效果，现报告如下。     

Differentiation of human epidermal stem cells into fibroblasts induced by TGF-β1 in vitro

Objective To investigate the correlation between human epidermal stem cell (hESCs) and hypertrophic scar or keloid. Methods Improved collagen Ⅳ-coated adhesion methods was used to isolate and culture the epidermal stem cells after neutral protease selectively digested the dermo-epidermal junctions. After the cells were cultured and expanded in vitro, and passage 3 hESCs were induced by different concentrations of TGF-β1 (0.1, 5.0, and 10.0 ng/ml). Morphological fea-tures and identification of these cells were meseasured by HE, Masson, immunohistochemical staining on the days 3 and 7, respectively. Results After induced by TGF-β1 for 3 and 7 days, the morpholo-gy of the epidermal stem cell (hESCs) was changed into fusiform shape, similar to fibroblasts. 70 % ofthe cell which was induced by TGF-β1 were blue stained in the cytoplasm by Masson stain, which is the distinctive method for collagen, suggesting collagen appeared or increased in the cells. The collagen concentrations in supernatants of hESCs were 0.4150±0.0014, 0.3380±0. 0020, and 0.3870±0.0020, much higher than that in control group (0.0780±0.0025) and normal skin fibro-blast group (0.15004±0.0051) (P<0.05). Immunohistochemical staining revealed that positive rates of these cells for anti-vimentin staining were more than (95.00±1.20)% in experiments and (5.70±0.20)% in control group. Conclusion The differentiantion of hESCs induced by TGF-β1 into fibro-blasts indicates that hESCs may play a role in the pathogenesis of hypetrophic scar and keloid.     

美容外科医疗文件的规范化初探之三--照相

一、美容手术术前术后相片拍摄原则相片作为医疗文件的重要组成部分,术前术后相片起着非常重要的作用,有评定手术效果、记录治疗过程等功能。但在目前,许多医院和医生因为不重视保存资料,使得很好的手术方法不能推广及得到学术界的认可,或是不能通过相片充分展示手术的效果;更有甚者,对手术相片进行造假,欺名盗世,滥竽充数。前者带来的后果或是流失宝贵资料,或是使医生在医疗纠纷发生时处于不利地位;后者是让虚假的“成果”充斥学术界,混淆视听。为提高美容外科术前术后相片的质量和水平,我们制定以下相片拍摄应遵守的基本原则。1.场地和设…     

超声波对机体组织及器官的安全性研究

因超声波具备的能量作用于人体组织,可能导致多种组织的不同程度的损伤,其安全性一直受到人的怀疑.本实验对11只香猪进行体内皮下组织超声波作用于组织,分别对肿胀液灌注和肿胀液灌注后进行超声波作用的香猪进行组织比较,初步观察超声波对组织的损伤情况.     

1050例混合型睑袋修复术的临床疗效探讨

目的：探讨一种新的肌皮瓣法行睑袋修复术，以获得符合美学标准的手术效果。方法：术前采用“皮肤夹捏法”确定去皮量。术中按照预先设计先切除皮肤，然后采用“肌肉拉放法”去除多余的眼轮匝肌，再切除松垂的眶隔脂肪或释放眶隔脂肪充填眶下缘凹陷。结果眼轮匝肌瓣法行睑袋修复术900例，术后发生暂时性睑外翻2例，暂时性复视2例，其余效果均较满意。外院150例并发症中，采用邻近皮瓣转移术、眼睑紧缩术、埋置皮肤软组织扩张器和颞浅筋膜悬吊等方法修复睑外翻15例，清除血肿28例，切除缝合修复瘢痕增生1例。结论：采用术前确定去皮量的肌皮瓣法，行混合型睑袋修复术，可以明显降低并发症的发生率，获得满意的临床效果。     

体象障碍患者对美容手术的满意度调查

目的 观察体象障碍患者在整形手术中的一般情况及其对手术的满意程度.方法 采用自制问卷调查21名体象障碍组和对照组对手术的满意程度及体象障碍组对两次手术的满意程度.结果 体象障碍组和对照组在手术满意度上有显著差异,体象障碍组的第1次与第2次手术的满意度有显著差异.结论 体象障碍患者对手术的满意程度较低,反复的手术导致更低的满意程度.     

Differentiation of human epidermal stem cells into fibroblasts induced by TGF-β1 in vitro

Objective To investigate the correlation between human epidermal stem cell (hESCs) and hypertrophic scar or keloid. Methods Improved collagen Ⅳ-coated adhesion methods was used to isolate and culture the epidermal stem cells after neutral protease selectively digested the dermo-epidermal junctions. After the cells were cultured and expanded in vitro, and passage 3 hESCs were induced by different concentrations of TGF-β1 (0.1, 5.0, and 10.0 ng/ml). Morphological fea-tures and identification of these cells were meseasured by HE, Masson, immunohistochemical staining on the days 3 and 7, respectively. Results After induced by TGF-β1 for 3 and 7 days, the morpholo-gy of the epidermal stem cell (hESCs) was changed into fusiform shape, similar to fibroblasts. 70 % ofthe cell which was induced by TGF-β1 were blue stained in the cytoplasm by Masson stain, which is the distinctive method for collagen, suggesting collagen appeared or increased in the cells. The collagen concentrations in supernatants of hESCs were 0.4150±0.0014, 0.3380±0. 0020, and 0.3870±0.0020, much higher than that in control group (0.0780±0.0025) and normal skin fibro-blast group (0.15004±0.0051) (P<0.05). Immunohistochemical staining revealed that positive rates of these cells for anti-vimentin staining were more than (95.00±1.20)% in experiments and (5.70±0.20)% in control group. Conclusion The differentiantion of hESCs induced by TGF-β1 into fibro-blasts indicates that hESCs may play a role in the pathogenesis of hypetrophic scar and keloid.     

表皮干细胞表型的成纤维样细胞在瘢痕中的表达

目的：探寻正常皮肤与增生性瘢痕中表皮干细胞标记物的表达,从组织学角度探讨表皮干细胞参与瘢痕增生的证据。方法：术中切取8例伤后6月增生性瘢痕患者的瘢痕组织及同例患者的正常皮肤,将其制备切片并分组,用E1iviSion二步法免疫组织化学检测表皮干细胞表面标志物β1整合素和CK19的表达,计数阳性细胞并进行统计学处理。结果：瘢痕组织真皮层中,表达阳性细胞数β1整合素和CK19较正常皮肤β1整合素和CK19明显增多（P〈0．05）,成纤维细胞数显著增多。结论：在病理性瘢痕的发生中,表皮干细胞可能在细胞因子作用下分化为成纤维细胞,从而参与瘢痕形成。     

自体脂肪移植联合A型肉毒毒素用于额部眉间充填除皱

自体脂肪细胞作为一种软组织充填物,移植用于局部充填可以,减轻额部及眉间衰老产生的皱纹,具有操作简便,组织损伤小,无异物排斥反应等优点。A型肉毒毒素是一种神经毒素,通过短期内麻痹局部肌肉,可以起到除皱的良好效果,在整形美容领域应用广泛。我们从2004年4月－2007年8月,在临床中将A型肉毒毒素与自体脂肪细胞移植联合应用于前额及眉间区域,既起到去除皱纹作用,又使局部丰满塑形,并且两者作用相互叠加,获得良好临床疗效。